How prevalent has an ADHD diagnosis become? One possible explanation for the frequency of the diagnosis is that the data collection method is imperfect. ADHD experts say it is often a pediatrician who does not spend the kind of time it takes to make an accurate diagnosis. The gold standard of ADHD diagnosis is an analysis of questionnaires, like those Connors developed, filled out by parents, teachers and other people who interact with the child and observe classroom behavior. Each child can take hours to analyze. The CDC, however, defends its figures.
In this case, scientists in the field do a full 2.
The percentage of children taking drugs jumped by more than a quarter, from 4. In fall and spring , there was even a brief shortage of ADHD drugs, particularly generics, because the demand was outpacing the supply. They include acting before thinking, being unable to delay gratification, staying motived to finish a boring task, keeping strong emotions in check, remembering an assignment and how to complete it, or planning ahead. But three other factors play a pivotal role in determining whether a child has a disorder or is just quirky, inattentive, or high-spirited.
To be diagnosed with ADHD, children must have most of those 18 symptoms, most of the time, in most areas of their lives, from home to school to the neighborhood playground. While kids with ADHD can be gregarious, their impulsiveness can create problems, often alienating others, including siblings, teachers, and classmates.
Generation meds: the US children who grow up on prescription drugs | Society | The Guardian
They may be hot-headed, lash out violently, or have temper tantrums. All of this carries enormous social cost in school and on the playground. But, in general, for a child with attention deficits, trying to focus on one thing is akin to trying to discern the chirping of crickets in Times Square. Some are chronically late. ADHD is divided into subtypes—children just with attention problems, those with impulse control and hyperactivity issues, and a group with a combination of the two. The latter is the most common, occurring in two-thirds to three-quarters of people, estimates Barkley.
Children with attention problems can have any or all of these symptoms, but may not be any more fidgety than the average child. On the other hand, children who are hyperactive as well as distractible may not be able to stop moving or even to stop talking, including to themselves.
An internal conversation for most people can become a conference call on speakerphone for a child with ADHD. The minute Saorla learned to walk she climbed—everything, and not skillfully.
She was impulsive, fearless and, probably as a result, accident-prone. The Meenaghs once had to call the police and fire department to get Saorla, then a toddler, out of a bathroom where she had barricaded herself behind a locked door and a drawer she pulled out. I worry about how this is going to play out. In fact, having ADHD makes you three times more likely to be dead by the age of Barkley is aware that he sounds alarmist, but he has good reason.
ADHD struck close to home, and with tragic consequences. His brother was killed in a one-car accident after drinking. He was not wearing a seatbelt. To say that ADHD is sometimes misdiagnosed—even over-diagnosed—is likely true, say many experts. Today we have brain scans, genetic studies, twin studies that show that this is a highly inherited neurobiological disorder, not some made-up condition. If the filter is too porous, too many stimuli get through. Scans show that those brain regions in children with ADHD are smaller than they are in children in the general population.
In one study done jointly by the Child Psychiatry Branch of the National Institute of Mental Health and McGill University in Montreal, brain scans of children with ADHD showed that the thickening of cortical tissue was delayed by about three years compared to scans of a control group of equal numbers of normally developing youngsters.
Generation meds: the US children who grow up on prescription drugs
The ultimate source of these brain differences is likely genes—perhaps thousands of them. The heritability of ADHD is striking. But this chemical that carries information between nerve cells plays a far more important function in human life than providing us with a cocaine or cupcake high. It uses reward—the pleasurable feelings it supplies—to motivate us to pay attention, avoid distraction, to pick out the most relevant information circulating in short-term memory when solving a problem or completing a task.
It also governs motion. Without dopamine, we might starve to death: There are dopamine receptors on certain neurons nerve cells to which dopamine delivers its various messages, such as pay attention, control yourself, feel good, and do that thing that made you feel good again, the latter reflecting its role in promoting both addiction and learning. Dopamine transporters also protrude from the neurons that produce dopamine. One particular gene, DAT-1, has been implicated in both ADHD and bi-polar disorder and is very active in the basal ganglia and pre-frontal cortex, the brain regions that are smaller in people with ADHD.
Other genes recently linked to the disorder strengthen the idea that ADHD is a fundamental communication system gone awry, a short-circuiting of the transmission between cells. There are some non-genetic risk factors for ADHD: A German study found a significant link between having eczema, a rash caused by allergies, and developing ADHD symptoms, giving more credence to a controversial theory that at least some ADHD is the result of allergies or sensitivities to certain foods, food additives, or other environmental chemicals.
Organophosphate pesticides—the kind used on most of the U. See other approaches to try. He made it to the front office before he was stopped. He recently graduated from Penn with a degree in physics. One of the clues that lead researchers to look at the dopamine genes as possible markers of ADHD is the effect of methylphenidate—the drug known as Ritalin, a central nervous system stimulant and one of the early drugs used to treat ADHD.
They can focus, control their emotions, keep internal conversations from becoming constant babble, and sit still long enough to learn. But the drugs work so well on symptoms that sales barely slowed in when the FDA—briefly—required them to carry a black box warning because of a small number less than 50 over 10 years of reported deaths, mostly related to heart damage. Another FDA panel withdrew the black box warning within a month. So why does stimulant medication given to high-energy kids calm them down? Today we know that stimulants such as Ritalin, Adderall and Vyvanse, like other drugs, have the opposite effect on children than the one they have on adults.
Diet, exercise, parenting techniques and therapy are extremely important as well. Yet the majority of children with ADHD are getting only medication. Choosing the Right Medication. Parents turn to drugs alone for a number of reasons. Experts such as Pelham, Koplewicz, Hallowell, and Barkley are all proponents of medication, but not necessarily as a first-line treatment. He laments that the takeaway from the MTA research has been that pills alone work.
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Research has produced evidence that good parenting can even trump bad genes. They also learn how to give instructions to a child whose short-term working memory is impaired and who finds it tougher than normal to keep distractions at bay. Parents practice ways to minimize their responses to minor annoyances—like a year-old who repeatedly puts her feet on the dining room table. This does not help.
Friedman, director of the psychopharmacology clinic at Weill Cornell Medical College, drew on the Kenya study, to suggest that many children with the genetic version of ADHD might benefit from education plans tailored to their needs for hands-on, fast-paced experiences high in novelty that, while unlikely to reduce their need for medication, could turn their disability into an asset. Kerri Meenagh was fortunate. That, she said, changed some of the expectations she and her husband have for their daughter—and themselves.
Basically, kids who have it are unable to concentrate, extremely restless, or both. The American Psychiatric Association calls the distinct types "inattentive" and "hyperactive-impulsivity. Others may be rebellious and reckless -- they can't wait their turn, keep quiet, or keep their friends. Still others have both kinds of problems. Don't be alarmed if those behaviors seem familiar: As your child enters his teens, he probably talks back, argues with his best buddy, loses his keys, or fails to finish his homework from time to time -- almost every kid does.
A child with ADHD will do these things more often though, unless he has a severe case, you wouldn't be able to pick him out from a group of kids watching TV. This can give him a real disability in school, at home, or in social settings. ADHD is controversial for two reasons: Researchers aren't sure precisely what causes it, and physicians, other medical experts, and parents all tend to have strong opinions on using drugs to treat it.
Signs usually appear before the age of 7. Studies indicate that more boys than girls are diagnosed with ADHD, and there is often a strong family history of other males with the condition. Boys may be more often diagnosed than girls is because they tend to be disruptive in school and attract the attention of teachers and parents. Girls are less likely to be noticed because the ADHD usually shows up in poor academic performance and less in hyperactive behavior.
Most researchers and ADHD experts believe the disorder has a neurological cause.
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Researchers are exploring the possibility that these kids inherit a physical inability to regulate levels of neurotransmitters substances that transmit signals in the brain , such as dopamine. Less plausible explanations include drug or alcohol abuse by the mother during pregnancy or psychological trauma early in the child's life.
But these hypotheses don't account for the vast majority of children with ADHD whose mothers didn't use harmful substances and who didn't go through emotionally rocky times as babies and toddlers. A minority of medical experts have argued that the ADHD diagnosis is overused for children who simply have difficulty adjusting to the structure of classroom life. If you're the parent of such a child, your child may not need medical treatment.
You may just need to exercise more patience and take responsibility for creating the right environment for your child to prosper in school, experts say. To be diagnosed with inattentive ADHD, your child must consistently exhibit six of the following symptoms for at least six months:. To be diagnosed with hyperactive-impulsivity ADHD, your child must consistently exhibit most of the following symptoms for at least six months:. Symptoms of ADHD must be apparent by the age of 7, though the disorder is most frequently diagnosed when kids are between 8 and According to the National Institute of Mental Health, half of all children with ADHD also have oppositional defiant disorder, which is characterized by stubbornness, outbursts, and belligerent behavior.
Make an appointment with your child's doctor if his behavior is hindering his academic performance or eroding his relationships at home or school. Disobedience that goes beyond normal rebellion, such as destroying property, also is cause for concern. Just because your child has reached or nearly reached his teens, don't think it's too late to seek professional help; in fact, it's probably crucial that you do so. Your child's doctor and a child psychologist or other mental health professional can assess his condition and work with you on a treatment plan that could make a big difference.
She'll perform a physical exam of your teenager and review your medical and social history. She may ask you about your pregnancy, family members who've been diagnosed with ADHD, and any emotional trauma your teen has suffered. Your child's doctor will also rule out obvious problems that could be causing your child to lose focus and fall behind in school, such as hearing loss or poor vision.
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But the result of the test can be useful in measuring memory, problem-solving, and listening skills. Your child's doctor will most likely refer you to a child psychologist, who will administer a battery of tests in addition to the IQ evaluation. One of these may be a "continuous performance test," which appraises attention span by having your child do boringly repetitive tasks on a computer. The psychologist will also ask you or your child's teacher to fill out one of the many rating scale forms, which present such questions as "How often does your child pay attention in class?
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Your child's doctor or psychologist also will assess him for the behaviors associated with ADHD in teens, such as excessive talking and interrupting. She will also evaluate him for oppositional defiant disorder.
Checking out conduct can be tough, however, since even kids with ADHD may not chatter or disobey during an office visit. The doctor may want to talk to your child's teachers about his behavior. Together, your child's regular doctor and the psychologist or other mental health professional can make a definitive diagnosis. There are three basic ones: Through family therapy or "parent training," you can learn more about ADHD and adjust your expectations for your child.
You can also learn to deal with your own frustration and to parent consistently and positively. Behavioral therapy can teach you how to structure situations at home and school so that your teen isn't confused about your rules or his responsibilities. Some medical experts feel that family counseling and behavioral therapy are enough to treat ADHD. Her "prescription" includes 1 no more than an hour a day of screen time; 2 getting enough sleep 9 to 11 hours ; 3 drinking 7 to 10 cups of water a day; 4 getting at least an hour of exercise each day.
Other experts have suggested using "nature therapy" -- that is, taking your child for hikes in parks and other natural settings -- to manage symptoms of ADHD. One study found children were able to concentrate better "shockingly better," as one researcher put it after taking a walk in the park rather than suburban streets.
Other experts believe in using medication to control the disorder. If a drug is part of the treatment plan for your child, you'll have to work with his physician or psychiatrist to find the right dosage. Ironically, the drugs most often prescribed are stimulants, including methylphenidate better known by its brand name, Ritalin and dextroamphetamine Dexedrine. Another drug used for ADHD is Adderall, an amphetamine; its slow-release formulation means kids don't have to take a second dose while they're at school.
Both classes of drugs have the potential for serious side effects, including heart rhythm problems, addiction, and psychosis, as well as others such as trouble sleeping, anxiety, irritability, headaches, and dizziness. The guide warns of the risk of cardiovascular complications and psychiatric problems -- such as hearing voices and paranoia -- in patients with no history of them. If your child develops these symptoms, talk with your doctor immediately about changing the treatment.
Patients or parents of children taking these drugs should talk to their doctors before altering or discontinuing treatment, however. The FDA has also issued an advisory on atomoxetine Strattera , a non-stimulant ADHD medication, warning of an "increased risk of suicidal thinking" in children and teenagers taking this drug. Researchers believe these medications help modulate levels of neurotransmitters in the brain. Side effects can include loss of appetite, stomach pain, insomnia, and rapid heartbeat. Long-term use of stimulants in children has been associated with slow growth, so the doctor will monitor your teenager carefully if she prescribes these medications.
However, stimulants can be habit-forming , so you may want to think about your long-term plan; some parents use medication to address immediate needs but see behavioral therapy as the key to a smoother road for their kids as they mature.